School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland.
Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand.
BMC Geriatr. 2019 Dec 19;19(1):357. doi: 10.1186/s12877-019-1305-x.
Prescribing for older people is complex, and many studies have highlighted that appropriate prescribing in this cohort is not always achieved. However, the long-term effect of inappropriate prescribing on outcomes such as hospitalisation and mortality has not been demonstrated. The aim of this study was to determine the level of potentially inappropriate prescribing (PIP) for participants of the Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ) study at baseline and examine the association between PIP and hospitalisation and mortality at 12-months follow-up.
PIP was determined using STOPP/START. STOPP identified potentially inappropriate medicines (PIMs) prescribed, START identified potential prescribing omissions (PPOs). STOPP/START were applied to all LiLACS NZ study participants, a longitudinal study of ageing, which includes 421 Māori aged 80-90 years and 516 non-Māori aged 85 years. Participants' details (e.g. age, sex, living arrangements, socioeconomic status, physical functioning, medical conditions) were gathered by trained interviewers. Some participants completed a core questionnaire only, which did not include medications details. Medical conditions were established from a combination of self-report, review of hospital discharge and general practitioner records. Binary logistic regression, controlled for multiple potential confounders, was conducted to determine if either PIMs or PPOs were associated with hospital admissions and mortality (p < 0.05 was considered significant).
Full data were obtained for 267 Māori and 404 non-Māori. The mean age for Māori was 82.3(±2.6) years, and 84.6(±0.53) years for non-Māori. 247 potentially inappropriate medicines were identified, affecting 24.3% Māori and 28.0% non-Māori. PIMs were not associated with 12-month mortality or hospitalisation for either cohort (p > 0.05; adjusted models). 590 potential prescribing omissions were identified, affecting 58.1% Māori and 49.0% non-Māori. PPOs were associated with hospitalisation (p = 0.001 for Māori), but were not associated with risk of mortality (p > 0.05) for either cohort within the 12-month follow-up (adjusted models).
PPOs were more common than PIMs and were associated with an increased risk of hospitalisation for Māori. This study highlights the importance of carefully considering all indicated medicines when deciding what to prescribe. Further follow-up is necessary to determine the long-term effects of PIP on mortality and hospitalisation.
为老年人开处方很复杂，许多研究都强调，在这一年龄组中，并非总能实现适当的处方。然而，不适当处方对住院和死亡等结果的长期影响尚未得到证实。本研究的目的是确定 Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ) 研究参与者在基线时潜在不适当处方 (PIP) 的水平，并检查 PIP 与 12 个月随访时的住院和死亡率之间的关联。
使用 STOPP/START 确定 PIP。STOPP 确定了开出的潜在不适当药物 (PIMs)，而 START 确定了潜在的处方遗漏 (PPOs)。STOPP/START 应用于 LiLACS NZ 研究的所有参与者，这是一项针对衰老的纵向研究，包括 421 名 80-90 岁的毛利人和 516 名 85 岁的非毛利人。受过培训的访谈员收集了参与者的详细信息（例如年龄、性别、居住安排、社会经济地位、身体功能、医疗状况）。一些参与者仅完成了核心问卷，其中不包括药物详细信息。医疗状况是根据自我报告、医院出院记录和全科医生记录的综合审查确定的。进行二元逻辑回归，控制了多个潜在混杂因素，以确定 PIMs 或 PPOs 是否与住院和死亡相关（p < 0.05 被认为具有统计学意义）。
获得了 267 名毛利人和 404 名非毛利人的完整数据。毛利人的平均年龄为 82.3(±2.6) 岁，非毛利人为 84.6(±0.53) 岁。确定了 247 种潜在不适当药物，影响了 24.3%的毛利人和 28.0%的非毛利人。PIMs 与两个队列的 12 个月死亡率或住院率均无关联（p > 0.05；调整模型）。确定了 590 种潜在的处方遗漏，影响了 58.1%的毛利人和 49.0%的非毛利人。PPO 与住院相关（p = 0.001，毛利人），但与两个队列在 12 个月随访期间的死亡率风险无关（p > 0.05）（调整模型）。
PPO 比 PIM 更常见，与毛利人住院风险增加有关。本研究强调了在决定开什么药时，仔细考虑所有指征药物的重要性。需要进一步随访以确定 PIP 对死亡率和住院率的长期影响。
